Office for National Statistics. Drug misuse in England and Wales: year ending March 2020. (accessed July 2023)
Skinner HA, Allen BA, McIntosh MC, Palmer WH. Lifestyle assessment: just asking makes a difference. Br Med J (Clin Res Ed). 1985; 290:214-216
Behforouz HL, Drain PK, Rhatigan JJ. Rethinking the social history. N Engl J Med. 2014; 371:1277-1279
Greenwood M, Meechan JG. General medicine and surgery for dental practitioners: part 1. History taking and examination of the clothed patient. Br Dent J. 2014; 216:629-632
Joshi S, Ashley M. Cannabis: a joint problem for patients and the dental profession. Br Dent J. 2016; 220:597-601
Gambhir R, Brar P, Anand S Oral health aspects of cannabis use. Ind J Multidis Dent. 2012; 2:507-511
Pertwee RG, Howlett AC, Abood ME International Union of Basic and Clinical Pharmacology. LXXIX. Cannabinoid receptors and their ligands: beyond CB1 and CB2. Pharmacol Rev. 2010; 62:588-631
Ashton CH. Pharmacology and effects of cannabis: a brief review. Br J Psychiatry. 2001; 178:101-106
Cho CM, Hirsch R, Johnstone S. General and oral health implications of cannabis use. Aust Dent J. 2005; 50:70-74
Engel JD. Cocaine: a historical and modern perspective. Nebr Med J. 1991; 76:263-270
Pennings EJ, Leccese AP, Wolff FA. Effects of concurrent use of alcohol and cocaine. Addiction. 2002; 97:773-783
Lee CY, Mohammadi H, Dixon RA. Medical and dental implications of cocaine abuse. J Oral Maxillofac Surg. 1991; 49:290-293
United Nations Office on Drugs and Crime. World drug report 2004. (accessed July 2023)
Tossmann P, Boldt S, Tensil MD. The use of drugs within the techno party scene in European metropolitan cities. Eur Addict Res. 2001; 7:2-23
Morton J. Ecstasy: pharmacology and neurotoxicity. Curr Opin Pharmacol. 2005; 5:79-86
Brand HS, Dun SN, Nieuw Amerongen AV. Ecstasy (MDMA) and oral health. Br Dent J. 2008; 204:77-81
Office for National Statistics. Deaths related to drug poisoning by selected substances, England and Wales. 2022. (accessed July 2023)
Global Drug Survey. Global Drug Survey 2014. (accessed July 2023)
Kaar SJ, Ferris J, Waldron J Up: The rise of nitrous oxide abuse. An international survey of contemporary nitrous oxide use. J Psychopharmacol. 2016; 30:395-401
van Amsterdam J, Nabben T, van den Brink W. Recreational nitrous oxide use: prevalence and risks. Regul Toxicol Pharmacol. 2015; 73:790-796
Abed H, Hassona Y. Oral healthcare management in heroin and methadone users. Br Dent J. 2019; 226:563-567
BMA. Drugs of dependence: the role of medical professionals. 2013. (accessed July 2023)
Centers for Disease Control and Prevention. People who inject drugs and viral hepatitis. 2019. (accessed July 2023)
Graham CH, Meechan JG. Dental management of patients taking methadone. Dent Update. 2005; 32:(8)477-8
Mental Health Foundation. Fundamental facts about mental health. (accessed July 2023)
Kalant H. Adverse effects of cannabis on health: an update of the literature since 1996. Prog Neuropsychopharmacol Biol Psychiatry. 2004; 28:849-863
Veitz-Keenan A, Spivakovsky S. Cannabis use and oral diseases. Evid Based Dent. 2011; 12
Darling MR, Arendorf TM. Effects of cannabis smoking on oral soft tissues. Community Dent Oral Epidemiol. 1993; 21:78-81
Schulz-Katterbach M, Imfeld T, Imfeld C. Cannabis and caries – does regular cannabis use increase the risk of caries in cigarette smokers?. Schweiz Monatsschr Zahnmed. 2009; 119:576-583
Darling MR, Arendorf TM. Review of the effects of cannabis smoking on oral health. Int Dent J. 1992; 42:19-22
Hoffman D, Brunneman D, Gori G, Wynder E. On the carcinogenicity of marijuana smoke. Recent Adv Phytochem. 1975; 4:63-81
Firth NA. Marijuana use and oral cancer: a review. Oral Oncol. 1997; 33:398-401
Rosenblatt KA, Daling JR, Chen C Marijuana use and risk of oral squamous cell carcinoma. Cancer Res. 2004; 64:4049-4054
Donald PJ. Marijuana smoking – possible cause of head and neck carcinoma in young patients. Otolaryngol Head Neck Surg. 1986; 94:517-521
Liu C, Qi X, Yang D The effects of cannabis use on oral health. Oral Dis. 2020; 26:1366-1374
Hashibe M, Ford DE, Zhang ZF. Marijuana smoking and head and neck cancer. J Clin Pharmacol. 2002; 42:(S1)103S-107S
Twardowski MA, Link MM, Twardowski NM. Effects of cannabis use on sedation requirements for endoscopic procedures. J Am Osteopath Assoc. 2019;
Dickerson SJ. Cannabis and its effect on anesthesia. AANA J. 1980; 48:526-528
Quart AM, Small CB, Klein RS. The cocaine connection. Users imperil their gingiva. J Am Dent Assoc. 1991; 122:85-87
Kapila YL, Kashani H. Cocaine-associated rapid gingival recession and dental erosion. A case report. J Periodontol. 1997; 68:485-458
Brand HS, Gonggrijp S, Blanksma CJ. Cocaine and oral health. Br Dent J. 2008; 204:365-369
Bahdila D, Aldosari M, Abdullah A Cocaine, polysubstance abuse, and oral health outcomes, NHANES 2009 to 2014. J Periodontol. 2020;
Friedlander AH, Gorelick DA. Dental management of the cocaine addict. Oral Surg Oral Med Oral Pathol. 1988; 65:45-48
Yagiela JA. Adverse drug interactions in dental practice: interactions associated with vasoconstrictors. Part V of a series. J Am Dent Assoc. 1999; 130:701-709
Goulet JP, Pérusse R, Turcotte JY. Contraindications to vasoconstrictors in dentistry: Part III. Pharmacologic interactions. Oral Surg Oral Med Oral Pathol. 1992; 74:(6)92-97
Hill GE, Ogunnaike BO, Johnson ER. General anaesthesia for the cocaine abusing patient. Is it safe?. Br J Anaesth. 2006; 97:654-657
Cheng DC. The drug addicted patient. Can J Anaesth. 1997; 44:(5 Pt 2)R101-111
Cafforio G, Morelli N, Rota E Cocaine-induced cluster-like headache. Neurol Sci. 2014; 35:319-321
Sacco R, Ball R, Barry E, Akintola O. The role of illicit drugs in developing medication-related osteonecrosis (MRONJ): a systematic review. Br J Oral Maxillofac Surg. 2021; 59:398-406
Vollenweider FX, Gamma A, Liechti M, Huber T. Psychological and cardiovascular effects and short-term sequelae of MDMA (‘ecstasy’) in MDMA-naïve healthy volunteers. Neuropsychopharmacology. 1998; 19:241-251
Solowij N, Hall W, Lee N. Recreational MDMA use in Sydney: a profile of ‘Ecstacy’ users and their experiences with the drug. Br J Addict. 1992; 87:1161-1172
McGrath C, Chan B. Oral health sensations associated with illicit drug abuse. Br Dent J. 2005; 198:159-162
Liester MB, Grob CS, Bravo GL, Walsh RN. Phenomenology and sequelae of 3,4-methylenedioxymethamphetamine use. J Nerv Ment Dis. 1992; 180:345-352
Biancardi M, Ortega R, De Albuquerque D Ecstasy abuse and its effects on the oral mucosa: two case reports. Oral Surg Oral Med Oral Pathol Oral Radiol. 2018; 126:e40-e41
Brazier WJ, Dhariwal DK, Patton DW, Bishop K. Ecstasy related periodontitis and mucosal ulceration – a case report. Br Dent J. 2003; 194:197-199
Goodchild JH, Donaldson M, Mangini DJ. Methamphetamine abuse and the impact on dental health. Dent Today. 2007; 26:124-131
Nugent G, Basyuni S, McAnerney D, Cameron M. Oral surgery: mutilation following MDMA. Br Dent J. 2017; 222
Kaar SJ, Ferris J, Waldron J Up: the rise of nitrous oxide abuse. An international survey of contemporary nitrous oxide use. J Psychopharmacol. 2016; 30:395-401
Moyes D, Cleaton-Jones P, Lelliot J. Evaluation of driving skills after brief exposure to nitrous oxide. S Afr Med J. 1979; 56:1000-1002
Randhawa G, Bodenham A. The increasing recreational use of nitrous oxide: history revisited. Br J Anaesth. 2016; 116:321-324
Sanders RD, Ma D, Maze M. Anaesthesia induced neuroprotection. Best Pract Res Clin Anaesthesiol. 2005; 19:461-474
Graham CH, Meechan JG. Dental management of patients taking methadone. Dent Update. 2005; 32:477-485
Raymond G, Maloney W. Methadone maintenance therapy and the dental patient. N Y State Dent J. 2015; 81:48-51
Titsas A, Ferguson MM. Impact of opioid use on dentistry. Aust Dent J. 2002; 47:94-98
Maloney WJ, Fleisher LR. The oral and dental significance of heroin and its resurgence in New York State. N Y State Dent J. 2016; 82:52-54
Lewis DA. Methadone and caries. Br Dent J. 1990; 168
Graham CH, Meechan JG. Dental management of patients taking methadone. Dent Update. 2005; 32:477-485
Charnock S, Owen S, Brookes V, Williams M. A community based programme to improve access to dental services for drug users. Br Dent J. 2004; 196:385-358
Heer M, Von Felten A. Immune thrombocytopenia in narcotics addicts. Ann Intern Med. 1985; 103
Ji Y, Kujtan L, Kershner D. Acute endocarditis in intravenous drug users: a case report and literature review. J Community Hosp Intern Med Perspect. 2012;
NICE. Prophylaxis against infective endocarditis: antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures. 2016. (accessed July 2023)
Scottish Dental Clinical Effectiveness Programme. Antibiotic prophylaxis against infective endocarditis. 2018. (accessed July 2023)

What's the deal? the importance of asking about recreational drug use in dental settings

From Volume 50, Issue 7, July 2023 | Pages 589-594


Onkar Mudhar

Dental Core Trainee 2, Oral Surgery/OMFS, Mid and South Essex NHS Trust

Articles by Onkar Mudhar

Natalie Bradley


Special Care Dentistry Registrar, Guy's Hospital, East Surrey Hospital, Royal Hospital for Neurodisability, Surrey and Sussex Healthcare Trust

Articles by Natalie Bradley

Email Natalie Bradley

Megan Samuel

BDS, MFDS RCPS (Glasg), PGCert Med Ed

Medical Student/OMFS Clinical Fellow, London

Articles by Megan Samuel


This article looks at the dental implications of the most commonly abused recreational drugs in the UK. It emphasizes the need for clinicians to have honest discussions with their patients and obtain this often overlooked piece of information. We discuss not only the oral manifestations and health implications of various recreational drugs, but also the impacts their use may have on a range of dental treatment. Furthermore, tips are given on how to obtain this often sensitive information.

CPD/Clinical Relevance: The use of recreational drugs has oral health implications and may impact on a range of dental treatment.


Recreational drug use in the UK is on the rise. In 2011, an estimated one in 11 adults aged between 16 and 59 years had taken a drug in the previous year (9.4% or approximately 3.2 million people), which was an increase from 8.6% in the year ending March 2010.1 Additionally, 2.1% of adults aged 16–59 years and 4.3% of adults aged 16–24 years were classed as ‘frequent’ recreational drug users (had taken a drug more than once a month in the previous year).1

This article explores the importance of including questions about recreational drug use as part of every patient assessment and the impact this can have on the provision of dental treatment.

Within the dental profession, there can be a reluctance to enquire about recreational drug use, often due to its illegal nature. Like any other aspect of history taking, it is crucial that a non-judgemental, professional tone is used. The use of open-ended questions that encourage discussion may also be of benefit.2 Dental professionals must gauge the level of appropriateness when asking these questions because patients may need to establish trust and rapport before sharing this information.3 To obtain a detailed social history, clinicians may want to undertake training in basic and motivational interviewing, and challenge themselves to examine their own biases. Unexplored prejudices may influence the ability to obtain, or act on, important information.3

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